September 22, 2020

Caribbean holiday: Fish supper that made a glass of cold water burn nurse’s hand


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By Diana Pilkington for the Daily Mail UK

Fish supper that made a glass of cold water burn my hand: Retired nurse Margaret explains how she was left with nerve poisoning by meal during a holiday
, 75, picked up a stomach bug in the Caribbean
The illness came on after she ate fish in a restaurant with husband Godfrey, 73
After weeks of symptoms Margaret went to the Hospital for Tropical Diseases
She was diagnosed with ciguatera, which comes from eating contaminated fish

There’s one souvenir none of us wants — a holiday illness no one can diagnose or treat. That’s where the Hospital for Tropical Diseases can help, as our occasional series reveals. Margaret Rydon, 75, a retired surgical nurse from Winchester, Hants, tells DIANA PILKINGTON her compelling story.

Recovering at home from a particularly nasty tummy bug I picked up in the Caribbean, the most bizarre thing happened: I picked up a glass of cold water and it felt very hot — my hands were burning. Then if I touched hot things, they felt freezing cold.

I also had pins and needles in my hands and legs. What I’d thought was ordinary food poisoning was anything but and my husband Godfrey, 73, insisted I see a doctor.

It all started a few weeks earlier, in January last year — we’d been going to the Caribbean twice a year to visit our daughter and her two children, who live on a small island.

Towards the end of our two-week stay, we had a dinner at one of our favourite restaurants — a beautiful place on the beach with first-class food. I had a light supper of snapper fillets and green beans.

I woke at midnight feeling horrendous and spent most of the night in the loo, being sick and with diarrhoea. By morning I was shattered. Later that day, my sense of balance disappeared. I couldn’t walk properly and had to hold on to things to stay upright.

Then on the second day, I was covered head to toe in a rash of small red, horribly itchy spots.

I saw out the end of our holiday surviving on Rich Tea biscuits and water, and using a walking stick, and needed a wheelchair to get around the airport.

By the time I got home to Winchester the diarrhoea, vomiting and itchiness had stopped, but I was still weak and dizzy with little appetite. I collapsed in a heap.

Things got worse: I couldn’t read a book for long before my eyes lost focus. I struggled to concentrate or remember things — even trying to address an envelope was too much for me to cope with.

And then about three weeks later, I developed the weird hot and cold sensations. We were very worried. I thought I was dying.

By that point I had an inkling what was wrong.

My daughter has lived in the Caribbean for 28 years and she wondered if it was ciguatera, a type of poisoning you get from eating contaminated fish.

The poison gets into your bloodstream and can affect your nerves and your organs, including the heart and the brain. It can even kill you, and I was terrified. But the GP had never heard of it and didn’t know where to start. That was when Godfrey decided I needed expert help.

The next day, we travelled to to the walk-in clinic of the Hospital for Tropical Diseases.

They said it was ciguatera and did blood tests to check it hadn’t caused problems with my organs.

The results were fine, but the problem is there is no specific treatment, which was frightening to learn.

What’s more, the poison can take up to a year to clear from the system — I wasn’t sure I could last that long, the way I felt. However they’d treated a previous patient with antidepressants, which eased the symptoms, even though he wasn’t depressed. I was willing to try anything.

I took the pills for two weeks, and avoided fish, chicken, pork, nuts, caffeine and alcohol. Apparently these may make the symptoms worse, though it’s not clear why.

On the day of my next hospital appointment — six weeks since I ate the snapper — I realised all my symptoms had disappeared. A year later, I’m back to normal.

I don’t blame the restaurant. They couldn’t have known the fish was contaminated.

My daughter tells me the problem mainly occurs in large fish that have been cut into fillets. So now, I only eat a fish that’s no bigger than a dinner plate.


Professor Rob Heyderman is a consultant physician in infectious diseases at the Hospital for Tropical Diseases, London.

Ciguatera is often mistaken for a holiday tummy bug. But it’s a type of food poisoning, mainly found in the Caribbean, that can affect anything from nerves to vital organs, and cause a variety of symptoms that may not appear until after you come home.

It’s also been reported around Florida, the Pacific islands, Hong Kong and Japan. Last year scientists said it appears to be moving north from the Tropics, as a result of rising sea temperatures.

People catch it by eating large reef fish that have ingested ciguatoxins — a poison found in a type of algae on coral reefs. The main fish associated with it are snapper, grouper, barracuda and eel.

Between 10,000 and 50,000 people worldwide are thought to develop the illness every year, but that could be a vast underestimate as some may not report it.

Margaret was lucky her daughter was familiar with it. Because it’s a poison, it can have a widespread effect once it gets into the bloodstream, affecting anything from the gut, to the nerves, to the brain, skin and, in rare cases, the heart. As well as potentially causing vomiting, diarrhoea and stomach pain, it can lead to aches, pains, pins and needles, numbness or itchiness because of its effect on nerves and other cells.

Unsteadiness is also common. And around half of patients will experience a tell-tale symptom known as ‘hot cold reversal’ — where hot things feel cold, and vice versa — because of its interference with nerves.

And because it can stop nerves working, some people may have seizures, or go into a coma. Their muscles gradually become very weak — if this affects the breathing muscles you may ultimately need to be put on a ventilator.

Very rarely ciguatera can kill: last year a British newlywed Christine Fensome, 54, died from a heart attack caused by ciguatera on honeymoon in Cancun, . Thankfully, in the majority of cases it’s not life-threatening and permanent damage is rare.

The illness can last up to a year, possibly longer, but should get better of its own accord once the poison leaves the system.


The Hospital for Tropical Diseases in London has a walk-in clinic for travellers who are acutely unwell.

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Nevertheless, it’s important to get checked out if you suspect ciguatera, because of the potential for serious consequences, and to rule out any other diagnosis.

Although there is no specific cure, we can offer treatments to ease symptoms while the patient recovers. If symptoms are very distressing, we may give amitriptyline — an antidepressant also used to treat nerve pain.

Unfortunately the poison isn’t destroyed by cooking, and you can’t taste or smell it.

But research suggests smaller fish — those weighing less than 2kg — carry a lower risk, perhaps because they can’t physically ingest as much poison. So it’s a good idea to avoid eating pieces taken from a large reef fish.

And apparently the toxins are more concentrated in the roe, head, skin and vital organs, so you may want to avoid eating these parts, or avoid fish soup that may contain a mix of them.

Apart from a handful of cases in Europe involving imported fish, ciguatera really only exists in the parts of the world where these reef fish are found.

Symptoms usually begin between 12 hours and five days of eating the contaminated fish. The toxin can cause anything from vomiting, diarrhoea and abdominal cramps to muscle weakness, itchy skin, rashes and dizziness. Difficulty breathing and bradycardia (a slow heart rate) are also possible.

Frightening experience: Margaret and Godfrey
Christine Fensome died from a heart attack caused by ciguatera while on honeymoon in Cancun, Mexico
Margaret picked up a particularly nasty tummy bug while on holiday in the Caribbean

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